Periodontal Associates Of South Bend

LBN: Periodontal Associates Of South Bend
Periodontal Associates Of South Bend is an health care organization with primary practice located at 1918 Edison Rd , South Bend IN 46617-1711. The organization recently has only one registered license in Dental Providers / Periodontics, which is considered as the primary health care specialty. Periodontal Associates Of South Bend can be contacted via phone (574) 287-8900, or through Royer, Gloria via phone (765) 447-9319.

Contact Information

Primary practice address
1918 Edison Rd South Bend IN 46617-1711
Phone: (574) 287-8900
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Royer, Gloria
Phone: (765) 447-9319

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Periodontics 1223P0300X

Profile Details

NPI number 1962078642
LBN Legal business name Periodontal Associates Of South Bend
DBA Doing business as
Authorized official Royer, Gloria
Entity Organization
Organization subpart 1 No
Enumeration date Jun 2nd, 2021
Last updated Jun 2nd, 2021 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962078642 NPPES
Indiana Other 12013130A DENTAL LICENSE

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